Medicare

FY 2019 Medicare SNF PPS Rate Calculator Tool

DISCLAIMER: This FY 2019 Medicare SNF PPS Rate Calculator is not an official CMS calculator. This calculator, with your facility-specific inputs, provides estimated SNF PPS rates and revenues based on tables from the final rule. We anticipate some technical correction updates from CMS, and possible minor calculation or rounding errors for some situations, but overall this tool should provide a close estimate on the revenue impact of all the payment adjustments that go into effect in FY 2019. This tool includes the 2.4% market basket rate increase, the SNF QRP adjustment (for affected facilities), the SNF VBP incentive payment multiplier, and sequester adjustment.

FY 2019 Medicare SNF PPS Rate Calculator Tool (Effective 10/01/2018)

Medicare Part B Fee Schedules

DISCLAIMER: These files are not official CMS files, although every effort was made to assure their accuracy for your needs. If in doubt, always refer to your Medicare contractor and/or the CMS website.

News & Resources

AHCA/NCAL Medicare Resources

Medicare-Medicaid Dual Eligibles

Medicare News

Accountable Care Organizations

ACO Toolkit - Members Only

Module 1 – Overview of the ACO Program: This module provides an overview of the structure, financial model and regulatory requirements of ACOS as well an understanding of how ACOs work including who can participate, beneficiary attribution, financial incentives, quality reporting and waivers.
Module 2 – Role of PAC and SNFs within ACOs: Building on Module 1, Module 2 provides a more detailed understanding of the role and opportunity for SNF/PAC into the ACO model.
Module 3 – ACO-SNF Contracting Guide: Module 3 highlights the key components in the development and negotiation of contracts between SNFs and ACOs including the key components of a contract, recommendations on terms that should (or should not) be in the contract, and important considerations for contract negotiation.

medicare_advantage

Medicare Managed Care

Managing Medicare Managed Care pulls together relevant existing AHCA/NCAL managed care resources.

Medicare Advantage (MA) is the managed care program within Medicare. It provides beneficiaries with the option to receive their Medicare benefits through private health plans. MA continues to grow rapidly and has doubled over the past decade to over 26 million people in 2021, which is 42% of all Medicare beneficiaries (see below). This growth is expected to continue as more and more individuals age 65+ are opting to have their care be managed by a private health plan and are attracted by the additional benefits that are offered through an MA plan. HMOs continue to account for the majority (62%) of all plans offered in 2021.

Managed Care Resources

Managed Care Playbook - 2018

The Managed Care Playbook (2018) is designed to assist AHCA/NCAL members operating Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALs) to better negotiate the terms of their agreements with MA and Medicaid Managed Care (MMC) plans. It is also intended to provide guidance on the following issues:

I. The legal authority of the CMS and individual state governments to oversee, and intervene in, contractual relationships between SNFs/ALs and MA / MMC plans;

II. Strategies to address common disputes between SNFs/ALs and MA / MMC plans; and

III. Legal actions available to SNFs/ALs to enforce their rights.

Medicare Advantage Toolkit Module I-III

The Toolkit is comprised of three modules:

I. A Primer on Medicare Advantage

II. Medicare Advantage Plan Reimbursement and Implications for Providers

III. Key Contract Components and Model Contract

The modules provide insight into the Medicare Advantage program and MA plans, including how MA plans are paid and their obligations to CMS, providers, and beneficiaries. It also outlines the components of a Medicare Advantage provider contract, key terms, and provisions.

‭(Hidden)‬ Contract Assessment and Return on Investment (CARI) - 2000

The CARI tool walks providers through the process for evaluating and understanding the real Return on Investment (ROI) of their Medicare Advantage contracts, ultimately assisting providers in determining whether remaining a network provider is worthwhile, or if other strategies may be more advantageous for both the provider and the residents.

BCPI